Journal of the American Society of Echocardiography
Original ArticlesRight atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension☆
Section snippets
Study group
From December 1993 to May 2000, 78 patients with pulmonary hypertension of diverse causes who were considered potential candidates for lung or heart/lung transplantation were prospectively and consecutively studied by the Echocardiography Section at the Institute of Cardiology and Cardiovascular Surgery-Favaloro Foundation. From this population, 25 patients (mean age: 37.6 ± 12.7 years [range: 20-59 years], 19 female [76%] and 6 male [24%]) who fulfilled the following inclusion criteria entered
Echocardiographic data
Complete measurements were obtained in 22 patients. AT, RVET, and AT/RVET were not measured in 1 patient and dP/dt was not estimated in 2 other patients because of suboptimal Doppler spectral signals of RVOT flow and TR, respectively.
Mean values and SD of analyzed parameters are depicted as follows: RV diastolic diameter: 40.92 ± 11.28 mm; LV diastolic diameter: 32.80 ± 7.4 mm; left atrial size: 13.34 ± 4.01 cm2; RAS: 28.24 ± 10.96 cm2; pulmonary artery diameter: 36.76 ± 8.05 mm; AT: 61.88 ±
Discussion
The prognostic value of echocardiographic parameters of cardiac anatomy, function, and hemodynamic state in patients with PPH was prospectively assessed in this study. In the multivariate analysis the RAS and the severity of TR were found to be predictive factors of mayor events (heart/lung transplantation and death) in the analyzed population (25 patients followed up by a mean period of 29 months).
One of the determinants of the RAS is the pressure on the atrium. As previously mentioned, the
Conclusions
RAS and the severity of TR, 2 parameters easily obtained by echocardiography, were predictive variables of survival free from transplantation in patients with PPH. The impact of these findings on the therapeutic management of this fatal illness should be addressed in larger prospective studies.
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Reprint requests: Dr Miguel H. Bustamante-Labarta, ICYCC, Fundación Favaloro, Sección Ecocardiografía, Av. Belgrano 1743, CP (1093), Buenos Aires, Argentina (E-mail: [email protected]).